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314 AYU-VOL. 30, NO.

3 (J ULY-SEPTEMBER) 2009
A Comparative Study on Shatavari and Kukkutanda Twak
Bhasma in Minimizing the Risk of Postmenopausal
Osteoporosis
J ASMINE J APEE (GUJ ARATHI) * M. A. PANDYA **
Institute for Post Graduate Teaching & Research in Ayurveda, Gujarat Ayurved University, J amnagar.
ABSTRACT : Postmenopausal period is a very vulnerable time for women, as she has to face inevitable scars of
menopause amongst which the most disabling one is Osteoporosis. The present study was aimed to compare the
effect of Shatavari and Kukkutanda twak bhasma in minimizing bone loss in menopausal and postmenopausal
period. The duration of treatment was 10 weeks along with diet restrictions. The results of Shatavari were
encouraging, as it has shown not only decrease in bone loss, but an significant increase in bone formation.
Key words : Postmenopausal osteoporosis, Shatavari, Kukkutanda twak bhasma, biochemical bone markers.
* Lecturer, Dept. of SRPT, G J Patel Ayu. Coll. & Research
Centre, New Vallabh Vidyanagar, Anand, Gujarat.
** Professor & HOD - SRPT, I.P.G.T. & R.A., J amnagar.
INTRODUCTION
Menopause is defined as the cessation of ovarian
function, resulting in permanent amenorrhoea. The
average age of menopause is usually around 50 years,
with limits between 45 and 55. Menopause apparently
occurs because of two processes. First, oocytes
responsive to gonadotropins disappear from the ovary,
and second, the few remaining oocytes do not respond to
gonadotropins. The menopause is a consequence of
estrogen deficiency due to the depletion, or relative
absence of primordial follicles responsive to the rising
levels of gonadotropins.
The postmenopausal period is associated with
significant increase in the incidence of age related medical
conditions like cardiovascular diseases and osteoporosis.
The care of elderly women should go beyond disease
orientation to include their total well being. Primary health
care and efforts to provide health services should be
directed to enable women to live healthy life as long as
possible.
Postmenopausal Osteoporosis is a condition of
major health importance which affects over one third of
all postmenopausal women with increasing morbidity and
mortality because of its association with fractures.
1,2
During the past decade, it has increasingly been perceived
as serious disabling disease needing substantial
involvement of all medical sciences to develop and assess
potential treatments. The use of HRT in managing this
condition is now questioned with increasing risks of
cancer and cardiovascular diseases with long term HRT
treatment.
3
Less effectiveness and more side effects of
other new therapeutics along with financial burden of
management of osteoporosis related fractures, has led
tremendous interest in herbal alternatives.
We, being the learners of great science of life -
Ayurveda, it is our moral duty to apply this invaluable
system of medicine to assist woman in journey towards
better health in the latter half of her life and add quality
to her life.
The present study was aimed in comparing the
efficacy of Shatavari and Kukkutanda twak bhasma in
decreasing bone loss, increasing bone formation and
hence minimizing the risk of postmenopausal osteoporosis.
MATERIAL AND METHODS
Clinical Study :
Patients : For clinical study, patients attending
OPD and IPD of I. P. G. T & R.A. hospital presenting
risk factors for developing the disease were registered.
Drugs : Shatavari moola churna, Kukkutanda
twak bhasma were prepared in the pharmacy of Gujarat
Ayurved Univeristy, J amnagar.
Criteria of Selection :
1. Women of age group 40 -60 years (perimenopausal
and postmenopausal age group)
2. Presenting one or more risk factors for developing
osteoporosis.
Criteria of exclusion :
1. Hyperparathyroidism.
2. Chronic diseases.
AYU-VOL. 30, NO. 3 (J ULY-SEPTEMBER) 2009, pp. 314 - 317
AYU-VOL. 30, NO. 3 (J ULY-SEPTEMBER) 2009 315
Criteria of Assessment :
Subjective criteria : Results of the treatment
were assessed on the basis of relief in Asthikshayatmaka
lakshana with the help of specific scoring pattern as
recorded in research proforma.
Objective criteria : To assess the effect of
treatment on bone loss, biochemical bone markers (Serum
Calcium, Urine Calcium, Serum Alkaline phosphatase )
were used before treatment (BT) and after treatment
(AT) to detect any change in rate of bone formation and
bone resorption.
Grouping :
GROUP A GROUP B
Drug Kukkutanda Shatavari
Twak bhasma Moola churna
Dose 500 mg / day 6 gm / day in
in 2 divided doses 3 divided doses
Duration 10 Weeks 10 Weeks
Anupana Milk Milk
No. of Patients 10 14
Pathyapathya according to the diet chart advised
to all the patients.
OBSERVATIONS
Maximum no. of patients i.e. 62.79% belonged
to the age group of 40-45 years. The 23.25% of patients
belonged to age group of 46-50 years, 11.62% of patients
were between age group of 51-55 years and rest 2.32%
of patients belonged to age group of 56-60 years. The
55.81% of patients were postmenopausal, whereas
44.81% fell into perimenopausal age group. Maximum
i.e. 55.81% of patients had less than 2 years as duration
of menopause. Total 83.72% of patients registered had
natural menopause whereas 16.27% underwent
hysterectomy. Total 34.88% of patients had age of
menopause between 40-45 and 45-50 years. The
23.23% of patients had menopause at age of 35-40 years
and 6.97% patients age of menopause was between
51-55 years. Maximum patients - (74.41%) were
housewives. The 67.44% of patients did not perform
any exercise in their daily routine. Vata dominant Prakriti
was found maximum number of patients with
combination of Pitta (58.13%) and Kapha (32.55%).
Avara Sarata was observed in 65.11% of patients.
Total 95.34% of patients had low life time calcium intake
as risk factor, 69.76% presented small body frame as
well as inactive life style whereas 48.83% were
underweight and 34.88% of patients had early menopause
as risk factor for developing osteoporosis.
Bone pain and low back pain was observed in
95.34%, extreme fatigue and cramps in legs in 90.69%,
difficulty in walking in 88.37%, premature graying of hair
in 67.44% and pain at symphysis pubis was observed in
60.46% of patients.
Radiological findings indicated established
osteoporosis in 18.60% of patients. Loss of normal lumber
lordosis was found in 23.25% of patients.
RESULTS
Effect of therapy in Group A :
Subjective Parameters : On Asthi Kshayatmaka
Lakshana, 66.66% relief in Keshapatan, 57.69% relief
in Asthi vedana, 50% relief in Shrama and 36.84% relief
in Sandhishoola was observed in this group which was
statistically highly significant. Whereas 33.33% relief was
observed in symptom of Katishoola which was statistically
non significant.
Objective Parameters : On biochemical bone
markers, Non significant change was seen in markers
of bone formation, Serum Calcium and Serum Alkaline
Phosphatase in this group.
Significant decrease (p<0.05) was seen in marker
of bone resorption, Urine Calcium, at the end of therapy.
Effect of therapy in Group B :
Subjective Parameters : On Asthi
Kshayatmatka lakshana:- 85.29% relief in Shrama, 80%
relief in Sandhishoola, 71.42% relief in Kesha patan,
70.37% relief in Katishoola and 68.57% relief was
observed in Asthivedana which were all statistically highly
significant. (p<0.001)
Objective Parameters : Biochemical bone
markers, highly significant (p<0.01) rise in the level of
Serum Calcium was seen in this group. Levels of Serum
Alkaline Phosphatase indicated non significant change.
Highly significant (p<0.01) decrease in levels of
urine calcium was observed.
Total Effect of Therapy :
In group A, marked improvement (75-100%
relief) was found in 10% of patients, 30% of patients
were moderately improved (50-75% relief) and 60%
patients showed mild improvement (25-50% relief) in
lakshana of Asthi kshaya. No patient remained unchanged
in this group.
In group B, marked improvement was found in
50% patients. The 42.85% patients were moderately
Shatavari and Kukkutanda Twak Bhasma in Postmenopausal Osteoporosis : Japee J. & Pandya M.A.
316 AYU-VOL. 30, NO. 3 (J ULY-SEPTEMBER) 2009
improved, 7.14% showed mild improvement and none of
the patient remained unchanged.
Results of Comparative Effect on Levels of
Serum Calcium and Urine Calcium in Group A
and Group B :
Changes in the levels of serum calcium and urine
calcium were compared and statistically analyzed through
unpaired student t test.
Serum Calcium : Treatment with Group B -
Shatavari, produced a highly significant increase
(p<0.001) in the levels of Serum Calcium at the end
point of 10 weeks as compared to Group A - Kukkutanda
twak bhasma.
Urine Calcium : Decrease in the levels of urine
calcium in Group B were statistically non significant
(p<0.10) when compared with the levels in Group A.
DISCUSSION
Reviewing all the available literatures related to
Asthi dhatu, the final diagnosis of the disease
osteoporosis was given as Asthi Saushirya and Anga
bhanga (fractures) can be considered as pratyatma
lakshana of this disease. Gambhira dhatu,
Svabhavabalapravritta Vyadhi and bhedawastha makes
this disease Kashta sadhya (Cha. Chi. 28/73-74).
Intervention at proper level, following pathyapathaya and
Rasayana Therapy makes it Yapya ( Su. Su. 21/35).
Maximum patients registered in the present study
had early menopause and had less than 2 years as duration
of menopause which supports the fact that age of
menopause is declining and that the bone loss is
accelerated in the first few years of menopause.
4,5,6
Low
life time Calcium intake and inactive life style were the
risk factors found in maximum number of patients which
serves as Nidana of Asthi Saushirya.
Effect of Shatavari on Asthi Ksayatmaka
lakshana was better over that of Kukkutanda Twak
Bhasma and placebo. The effect of Shatavari on bone
markers indicates that it enhances bone formation as well
as decreases bone resorption. It acts on both ways and
balances bone remodeling and hence can prevent bone
loss and help in increasing bone mass. Shatavari has
immune enhancing property by means of enhancing
defense functions like leucocytosis and neutrophilia.
14
Predominant cornification of epithelial cells have been
observed due to presence of estrogenic activity in
shatavari.
The mode of action of Shatavari can also be
explained with the help of its active chemical constituent
- Steroidal Saponins which fall under Phytoestrogens.
7,8,9
Phytoestrogens acts as SERMs (Selective Estrogen
Receptive Modulators).
10
They stimulate osteoblastosis
and suppress osteoclastosis and thus help in preventing
bone loss.
11
CONCLUSION
Postmenopausal osteoporosis is a disabling
disease which renders women a bedridden life. Hormone
replacement therapy- only known therapy in prevention
and management of postmenopausal osteoporosis has got
major risks than benefits. The medical community is in
search of a better, safer, less expensive and more
convenient antiresorptive agents and regimens.
Postmenopausal Osteoporosis can be termed as
Rajonivrittijanya Asthi Saushirya. From the present study
it can be concluded that the effect of Shatavari on Asthi
Kshayatmaka lakshana was better over Kukkutanda
twak bhasma. Shatavari provided encouraging results on
bone metabolism by preventing bone loss and enhancing
bone formation.
The unpaired t test which was done to compare
the results in Group A and Group B indicates that Group
B showed highly significant rise in the levels of Serum
calcium as compared to Group A. Additional studies by
combining Shatavari with calcium supplements and life
style planning are needed to improve the quality of life of
postmenopausal women.
REFERENCES
1. Melton L. J ., Chrischilles E. A., Cooper C., Lane A. W., Riggs
B. L. How many women have osteoporosis J . Bone Miner Res;
7 : 1005-1010, 1992.
2. Riggs B L, Meltoon L J III. Involutional Osteoporosis. N. Engl
J . Med ; 314:1676-86,1986.
3. Grady D., Herrington D., Bittner V., Cardiovascular disease
outcomes during 6-8 years of hormone therapy : Heart and
Estrogen/ Progestin Replacement Study follow up (HERS II)
J AMA; 288:49, 2002.
4. World Health Organisation. Assessment of fracture risk and its
application to screening for postmenopausal osteoporosis.
Geneva : WHO 1994 (Technical report series 843).
5. Stevenson J . C., Banks L. M., Spinks II et al. Regional and Total
skeletal measurement in early Menopause. J . Clin Invest; 80:
28-62, 1987.
6. Wark J . D. Osteoporosis : Pathogenesis, diagnosis and
management. Bailliers Clin Endocrinol metab; 7: 151-81, 1993
7. Indian Medicinal Plants by Kirtikar K. R. & Basu B. D. 1981
8. Indian Materia Medica by A. K. Nandkarni, Popular Prakashan,
3
rd
Edition: 1954.
9. Wealth of India, Vol I: A, Publication and Information
Directorate, New Delhi, 1985.
10. Brezinski, A and Debi A. Phytoestrogens : The natural selective
estrogen receptor modulators. Eur. J . Ob. & Gyn. & Rep. Bio
85, 47-51. 1999.
11. Knight D. and Edan J . A. A review of the clinical effect of
phytoestrogens. Obstet. Gynecol. 87 : 897, 1996.
AYU-VOL. 30, NO. 3 (J ULY-SEPTEMBER) 2009 317
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Shatavari and Kukkutanda Twak Bhasma in Postmenopausal Osteoporosis : Japee J. & Pandya M.A.

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